The year of the horse placenta

Abstract

We are in the Chinese year of the ox but in the UK this could end up being the year of the horse placenta. Some of you may be out of touch with the surreal world of Premier League football. All you need to know is that several star players, multimillionaires for running around a lot and occasionally kicking a ball straight, have visited a Serbian therapist or housewife – depending on which report you read – called Mariana for treatment of joint injuries. Mariana specializes in ankles, knees, hamstrings and calves, an ideal portfolio to attract rich young footballers to her clinic/house/underground lair. Mariana can reduce recovery time from eight weeks to two days, a mind-boggling result that defies laws of tissue injury and healing. Of course, Mariana's methods are something of a mystery. The word is that she applies or injects a cream or liquid to the injured body part, and that her concoction contains stem cells from human or horse placenta. Please excuse these imprecise facts, although understandably the horse placenta theme has captured the media's imagination. She does or does not then apply electrical impulses to the injured area to stimulate regeneration. The player may or may not recover faster than expected. Is this progress? Two hundred years after the birth of Charles Darwin and 500 years after the birth of Henry VIII's reign – a reign that might have gone differently had he applied horse placenta to his chronic leg ulcers (JRSM 2009;102:512–16) – have we finally stumbled upon a wonder cure that has always been within our grasp, because that is what this must be? Either that or the medical staff at some of the richest football clubs in the world have some awkward questions to answer. Would you send a prized asset worth between £20m and £50m for an unproven treatment that has never been tested in a randomized controlled trial – or tested in any worthwhile manner for that matter? What if this therapy ended a player's career? Perhaps I have no faith? All literature searches for a paper on the wonders of horse placenta massage or injection have been fruitless. Perhaps a JRSM reader can point me in the direction of the scientific evidence? The football clubs themselves are summarily unable to. Their consideration of the evidence on this untested therapy has concluded that it is worth trying because it ‘doesn't cause any harm’. How would they know? But the players return from Serbia smiling, and their fans are filled with optimism their heroes will be back in action sooner than expected. Even my own support for Liverpool was only temporarily shaken when they sent almost half their first team to Mariana's healing hands. What if she were a Manchester United fan? Meanwhile, whether horse placenta is any better than horse dung is not known, its long-term implications unevaluated, and its comparison with placebo unconsidered. This fashion for horse placenta therapy shows how the world of medical science is quickly marginalized by more powerful arguments of politics and money. Here the concern is league position and money, money and television rights deals. When Professor David Nutt was sacked as the government's chief drugs advisor, politics mattered more than scientific debate. Political parties, like football clubs, use science to support their arguments and their decisions, and they cherry-pick the evidence as much as they wish. It is foolishly optimistic to believe politicians carefully consider the evidence before introducing a policy. Their political lives and motivations are far too short-term. Their promises to the public focused on what they will do to our lives in the next months rather than next decade. And we enter another decade struggling to appreciate how the world of medical care is better informed by science? As several articles in this issue show, our best option might be turn to the humanities (JRSM 2009;102:518–20), environmental harmony (JRSM 2009;102:551–3) and friendship (JRSM 2009;102:502–3) to restore some faith in our profession (JRSM 2009;102:553–5). Failing that, we might turn to computer games (JRSM 2009;102:500–1) or drugs (JRSM 2009;102:544–6), but there is evidence they cause harm – unlike horse placenta, which football clubs are convinced doesn't. Bertrand Russell asked whether it is possible for a scientific society to exist, or must such a society inevitably bring itself to destruction? Perhaps he should have asked a simpler question: ‘Is it possible to create a scientific society?’ All we have managed to prove is that it is possible to create a society that survives on blind faith and a rudimentary understanding of politics and football.